Psychotherapy and the Everyday Life: A Guide for the Puzzled Consumer

Psychoanalytic psychotherapy is in every way a perplexing business. Through a frank dialogue between a former patient and her former therapist Psychotherapy and the Everyday Life introduces psychodynamic therapy to prospective and beginning patients. It addresses individuals who are seeking psychological help and wish to determine whether this particular form of psychotherapy is appropriate for them. It is also intended for those whose therapy is already underway, to assist them in furthering understanding and clarifying their experience so that they can better avail themselves of what it has to offer. The book can also serve as a reminder to novice professionals (and perhaps some more experienced professionals as well) concerning what psychotherapy feels like from the patient's point of view and what complexities of response and intention lie behind the therapist's interventions. [It] is not meant to substitute for the psychodynamic conversation that is therapy itself. Rather, it is an attempt, in straightforward, non-professional language, to help facilitate the clinical experience.

Curiosity about one's own inner life is both a prerequisite of psychotherapy and one of its benefts. The famous psychoanalyst D.W. Winnicott was once asked by a priest during a public lecture how to determine when he should himself listen to his parishioners’ complaints and when he should send them for professional help. Winnicott answered, “If a person comes and talks to you and, listening to him, you feel he is boring you, then he is sick and needs psychiatric treatment. But if he sustains your interest, no matter how grave his distress or confict, then you can help him all right.”1 Psychotherapeutic story-telling has to do with recovering and maintaining your interest in yourself, especially when you might be experiencing yourself as the least interesting organism on the planet.

The psychodynamic view of psychological dis-ease

Most of us do not go into therapy because we've suddenly developed an overwhelming interest in our life stories. We go into therapy because we are experiencing psychological pain, often quite acutely. We seek therapy (of whatever kind) because of feelings of what we might want to call psychological dis-ease. Psychological dis-ease can be any one of a number of states of mind that make us feel uneasy or unwell: anxiety, depression, sadness, anger, conficts that seem irresolvable, life situations that seem unbearable, feelings of failure, frustration, helplessness. These dis-eases, like physical diseases, can be chronic or acute. They can be extremely serious, even life-threatening, or they can be rather ordinary and mundane, like the common cold. And as is also the case with diseases of the body, so with these dis-eases of the mind or spirit, we seek help from professionals in order to feel better. But unlike diseases of the body, dis-eases of the spirit cannot usually be treated exclusively through drugs, surgery, plaster casts, braces and other more external, mechanical means. Our thoughts and feelings may well originate in the physiological processes of the body. They may even, as some recent theories suggest (we'll get to these later), be simply another way of viewing those processes. Many emotional conditions can for this reason be treated (at least in part) through medication, as the increasingly popular use of Prozac and other antidepressants more than confrms. Nonetheless, our feelings and emotions are no more identical to the physiological processes of the body than those processes are identical to one another. To sneeze is one thing, to walk is another, and to worry about a job, or sorrow over the death of a friend, or fall in love is something else again.

That we have a dynamic unconscious and defence mechanisms that can be engaged and refected upon in a certain way does not prove that psychoanalytic psychotherapy is the best way to address psychological dis-ease. As we've already noted, the opportunity that psychotherapy (like other therapies) affords of talking with another human being about what is troubling you often provides some measure of immediate relief from psychological distress. But, as we've also said, such relief is not the only or often the primary or initial goal of psychoanalytic psychotherapy. Unlike other forms of therapy, psychoanalytic psychotherapy is directed towards helping us to see and refect on the unconscious processes of mind despite our decided resistances to doing so. It is more than legitimate to ask why one might prefer a form of therapy that very often not only doesn't produce immediate, instant relief, but even adds some considerable measure of frustration of its own.

The claim for the effcacy of psychotherapy is not a claim that any of us ought to take simply on faith. Later in this book we will specify some of the reasons for preferring psychodynamic psychotherapy over other forms of psychotherapeutic interventions. For the moment, however, we wish to return to the subject of resistance in and to therapy and how it works. Even if the arguments in favour of psychotherapeutic intervention are compelling, to take advantage of what psychotherapy has to offer you have to want for yourself the specifc things that psychotherapy can give you. Other forms of therapy may well be preferable for individuals who want the benefts that those therapies can offer. Part of the purpose of this book is to specify up front the special offerings psychotherapy promises, even—or especially—for those of us in psychic pain, so as to help you decide whether this is the therapy for you. Getting past that initial resistance to therapy is only one of many hurdles that one has to negotiate in psychotherapy. Since it is the hurdle that determines whether there will be any further hurdles in the future, it is the one we are addressing frst. So let us return to the matter of resistance.

No matter how much psychotherapy or even psychoanalysis we have had, we can never know directly the unconscious contents and processes of mind. We can only come to know the derivatives or precipitates of those contents and processes as they manifest themselves in our behaviour and words, thoughts and feelings. In other words, we come to know of the existence of the dynamic unconscious and what it is communicating to us in the same way that we come to realize that some internal, organic process has ensued when we walk across the room or read a book or even think a thought. We know not because we are conscious of the unconscious processes that produce the action (which are, in the case of walking or eating, physiological processes). Rather, we know because we become aware of the tangible consequences of those processes. In a similar way, even if we do not directly perceive our unconscious wishes and desires, and therefore even if we cannot consciously articulate them, these wishes and desires do manifest themselves in our behaviour, including the words we speak. Let us say that the unconscious contents of mind don't so much speak to us (the way our conscious thoughts of this or another subject or feeling do) as they speak through us. They manifest themselves and achieve expression in our various behaviours, including our emotional responses and reactions, and often in the words we speak as a part of those behaviours and feelings.

Psychotherapy has been around for as long as human beings have been engaged in serious conversation with each other; for essentially that is what psychotherapy is. It is a conversation between two individuals. What is special about this conversation, as we have said, is that it is an asymmetrical story-telling conversation, in which one of the parties to the conversation (the therapist) tries to help the other (the patient) to cope with some sense of dis-ease or dissatisfaction or dysfunction in his or her life. The story-listener (the therapist) also doesn't simply listen to the patient's narrative. Rather, he tries to help the story-teller hear and then re-tell his own story with increasing depth and clarity. The listener (therapist) tells the story back to the patient (highlights features, invites the storyteller to refect on aspects of the story, asks questions about the story), such that the story-teller can take his story back again with greater self-knowledge and personal understanding, especially of the story's unconscious dimensions.

The transference relationship between the patient and the therapist is a major component of the psychoanalytic psychotherapeutic process. In large part it is what distinguishes psychotherapy from other kinds of psychological therapies. Despite the terror and comedy that this term sometimes produces, transference really isn't anything more than a particular expression—in the clinical setting—of the way in which all of us tend to have typical responses and reactions to one or another situation. As psychoanalytic theory has begun to acknowledge more and more, transference doesn't involve only the specifc unconscious memories of mind. Rather, what are also—and perhaps more importantly—transferred in the clinical relationship are our typical ways of relating and reacting. These ways we have of relating and reacting may largely construct and be constructed by the more autobiographical narratives, but they are not synonymous with those narratives. Nor does the way we have of transferring patterns of behaviour and feeling from one situation or person to another, which characterizes both our everyday lives and the clinical relationship, necessarily doom us endlessly to repeat the same behaviours and responses ad infnitum. To be sure, there are psychological disorders and certain forms of neurotic behaviour in which such repetition is the presenting symptom. Nonetheless, for most of us the ability to transfer thoughts, feelings and reactions from situation to situation and person to person is a necessary tool of survival. It is—or at least might become—the usefully fexible grid on which we plot our past experiences in order to produce new future realities. The flm Groundhog Day is a perfect illustration of the difference between the unconscious recycling of patterns of thought and feeling, and the accommodations and transformations that insight and refection can produce. In the movie the protagonist wakes up day after day to the same day and stupidly repeats the same unsatisfying and self-defeating behaviours, until gradually he begins to recognize those behaviours (if not backwards to their past origins, at least as mindless repetitions of each other) and thereby to change them. The protagonist not only comes to learn something signifcant about himself, he also succeeds in transforming himself in fundamental and useful ways. Conscious awareness of our habitual modes of transference can well yield new mental patterns and new sets of different future possibilities.

The analogy often attached to psychoanalysis, and thereby to psychotherapy is that it is like archaeology. You dig and dig into the unconscious contents of the mind until you fnd the particular artefacts that give you a picture of the earlier life of that mind. Freud himself was a great collector of antiquities, as any visit to the Freud Museum in London will verify. He himself illustrated the parallel between archaeology and psychoanalysis. But psychoanalysis and psychotherapy are at least as much like gardening as archaeology. The archaeological metaphor preserves the intellectual content of that layer upon layer of accumulated history. But it loses the all-important, equally prominent dynamic, organic quality of the mind's accretions. Transference is the key to this vital, living, transformational quality of the mind. In psychoanalytic psychotherapy you dig down to a living root which is not mummifed or petrifed or in the least dead. You travel its constantly changing, self-transformational growth, along its length and onto its various branches. You can only travel one of these roots or branches at a time, and even that single branch isn't unifed. Each branch itself branches off and is, like the root and all its other branches, also in the process of growing and changing. And then maybe you travel another similarly dynamic branch. And then maybe you look back at the root and see these different branches in relation to each other. But by tomorrow each branch will have changed. The root will have changed. And the overview will have to take into account something that simply wasn't there the day before.

In psychoanalytic psychotherapy the patient is the dynamic, active agent. He is the one who is telling and retelling his story transferring feelings onto his therapist and dramatizing the inner psychodynamics of self in the clinical setting. All of this self-enactment will eventually become the materials of the patient's own self-refections. What, then, is the therapist doing all this time, such that he should get paid for his services? In one of Woody Allen's earliest stand-up routines he confesses rather wryly that it took him six months to realize that his strictly Freudian analyst had died. Sometimes even psychotherapy, which isn't psychoanalysis proper, feels like that: as if there is absolutely no one in the room with you.

But of course there is someone else in that room with you. The very fact that someone is listening to you tell your story and watching you perform yourself is a part of how therapy works. Freud's “talking cure” is as much a “listening cure”. As we have already said more than once, sometimes we just need to be heard (and seen) to confrm or validate that we, our feelings and our experiences exist in a world of other people. We need to know that other people can witness these things about us, and that not only can they (like us) survive them, but they can even understand and empathize with us. Sometimes what someone else's silent, listening presence gives us is comfort. It helps us know we are not alone.

Although there are many different kinds of psychological therapies, the majority of them can be divided into two major camps: the psychodynamic psychotherapies and the non-dynamic therapies. Any reader who has made it this far in reading this book is probably inclined to the project of expanding and deepening self-awareness. This is largely the domain of psychodynamic psychotherapy specifcally of the psychoanalytic variety that has been our primary subject. Psychotherapy of this sort has achieved enough positive results over the years not to need special defending. Recent developments in psycho-neurobiology may help suggest how these results have come about. They enable us to glimpse how on the neurological level (and not only psychologically or cognitively) talking functions materially literally to change how we think and feel. We do not intend the following foray into the fascinating feld of neurobiological and neuro-psychoanalysis to be either exhaustive or deep. Yet even from a non-professional vantage point, looking for a moment at the psychological structures and functions of the brain from a neurological point of view can usefully supplement the more psychological view of the human mind we have heretofore been providing.

The “we” in the title of our afterword could be an impersonal frst person plural, referring primarily to those of us who have completed the psychotherapeutic process: where do “we” fnd ourselves psychologically after psychotherapy? To some degree this fnal chapter does deal with this aspect of the aftermath of therapy. More important, perhaps, than the process itself is where that process takes us for the rest of our lives. But this fnal chapter has another subject as well. It is an attempt to make good on the unique situation of the co-authorship of a former therapist with his former patient. The “we” in our title, then, is also a personal “we”. It also refers to the two individuals who have written this book. This chapter will deal with the transformation in the relationship between the former therapist and the former patient, which occurred when they came together to write this book. In general, the relationship between the therapist and the patient ends with the end of the therapy itself. In the case of this book, that relationship was quite atypically revived some years later in the radically different form of a writing partnership. In this fnal chapter we want to refect on the psychotherapeutic process from within that change in our relationship.